دورية أكاديمية
Volumetric effect of shunt adjustments in normal pressure hydrocephalus: a randomized, double-blind trial.
| العنوان: | Volumetric effect of shunt adjustments in normal pressure hydrocephalus: a randomized, double-blind trial. |
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| المؤلفون: | Lidén S; 1Department of Medical Sciences, Neurology, Uppsala University, Uppsala Län.; 2Department of Neurology, Östersund Hospital, Östersund, Region Jämtland Härjedalen., Farahmand D; 3Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Västra Götalands Län; and., Laurell K; 1Department of Medical Sciences, Neurology, Uppsala University, Uppsala Län.; 4Department of Biomedical and Clinical Sciences, Neurology, Linköping University, Linköping, Östergötlands Län, Sweden. |
| المصدر: | Journal of neurosurgery [J Neurosurg] 2023 Nov 17; Vol. 140 (5), pp. 1493-1500. Date of Electronic Publication: 2023 Nov 17 (Print Publication: 2024). |
| نوع المنشور: | Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 0253357 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1933-0693 (Electronic) Linking ISSN: 00223085 NLM ISO Abbreviation: J Neurosurg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Charlottesville, VA : American Association of Neurological Surgeons Original Publication: Chicago [etc.] |
| مواضيع طبية MeSH: | Hydrocephalus, Normal Pressure*/surgery , Hydrocephalus, Normal Pressure*/diagnostic imaging , Magnetic Resonance Imaging* , Cross-Over Studies*, Humans ; Double-Blind Method ; Male ; Female ; Aged ; Aged, 80 and over ; Cerebrospinal Fluid Shunts/methods ; Middle Aged ; Cerebral Ventricles/diagnostic imaging ; Cerebral Ventricles/surgery ; Treatment Outcome ; Ventriculoperitoneal Shunt |
| مستخلص: | Objective: MRI volumetry could be used as an alternative to invasive tests of shunt function. In this study, the authors aimed to assess the difference in ventricular volume (VV) before and after surgery and at different performance levels (PLs) of the shunt. Methods: This study was a randomized, double-blind trial with a crossover design. The study sample consisted of 36 patients (25 men, 11 women) with a median age of 76 years. All patients had idiopathic normal pressure hydrocephalus (iNPH) and received a Strata shunt at the regional hospital in Östersund, Sweden, with an initial PL of 1.5. Participants underwent MRI with volumetric sequences before surgery and four times postoperatively: at 1 month before randomization to either PL 1.0 (n = 15) or 2.5 (n = 17); at 2 months before crossover to PL 2.5 or 1.0; at 3 months before lowering the PL to 0.5; and finally, at 3 months and 1 day after surgery before resetting the PL to 1.5. VV was measured semiautomatically using quantitative MRI. Both the patient and the examiner of clinical tests and volumetry were blinded to the PL. Results: VV changed significantly between the presurgical level (median 129 ml) and the different shunt settings, i.e., PL 1.0 (median 115 ml), 1.5 (median 120 ml), and 2.5 (median 128 ml; p < 0.001). A unidirectional change in VV was observed for all participants between PL 1.0 and PL 2.5 (median 12 ml, range 2.1-40.7 ml, p < 0.001). No significant change was noted in VV after 24 hours at PL 0.5. Eight participants had asymptomatic subdural effusions at PL 1.0. Conclusions: The consistent decrease in VV after shunt surgery and between PL 2.5 and 1.0 supports the idea that MRI volumetry could be a noninvasive method for evaluating shunt function in iNPH, preventing unnecessary shunt revisions. However, further studies on retest variability of VV as well as verification against advanced testing of shunt function are needed before a clinical implementation of this method can be performed. Clinical trial registration no.: NCT04599153 (ClinicalTrials.gov). |
| فهرسة مساهمة: | Keywords: cerebral ventricles; cerebrospinal fluid shunt; idiopathic normal pressure hydrocephalus; magnetic resonance imaging; performance level; shunt adjustment; ventricular volume |
| سلسلة جزيئية: | ClinicalTrials.gov NCT04599153 |
| تواريخ الأحداث: | Date Created: 20231117 Date Completed: 20240501 Latest Revision: 20240501 |
| رمز التحديث: | 20240502 |
| DOI: | 10.3171/2023.9.JNS23668 |
| PMID: | 37976516 |
| قاعدة البيانات: | MEDLINE |
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